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MF2 Renal Objectives

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Objectives	Linked Activities	McMaster Program Competencies
General Objectives
Explain the structure, function and physiology of the urinary tract, kidney, nephron and glomerulus	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules). Tutorial: Celia and Maria MF2 Renal Maria is a 33 year old single woman who is concerned about the health of her 2 year old daughter Celia. Since three months of age Celia has been treated with multiple course of antibiotics for episodes of fever and irritability. Maria wants the doctor to check a urine sample because she thinks it might be a "urine infection" since Celia's wet diapers have a bad smell Tutorial: Ivan Horvath MF2 Renal Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Describe renal and bladder anatomy and visualize with an ultrasound.	Tutorial: Celia and Maria MF2 Renal Maria is a 33 year old single woman who is concerned about the health of her 2 year old daughter Celia. Since three months of age Celia has been treated with multiple course of antibiotics for episodes of fever and irritability. Maria wants the doctor to check a urine sample because she thinks it might be a "urine infection" since Celia's wet diapers have a bad smell	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe normal renal pathology.	Active Large Group Session: Introduction to Renal Pathology	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Explain the concept of glomerular filtration rate and renal clearance of solutes, drugs and toxins.	Tutorial: Nancy Jones MF2 Renal Nancy Jones is a 34-year-old Mohawk, Turtle Clan woman who has been well until four days prior to hospital admission when she developed abrupt onset of chills, rigors, and a productive cough. Subsequently Mrs. Jones became progressively short of breath, was obtunded and bedridden and was brought to the hospital emergency room. On arrival, her vital signs were blood pressure 80/60 mmHg, heart rate 148 beats/min, respiratory rate 42/min, temperature 39.6o C, and oxygen saturation 79% on room air. She was confused. Crackles were heard on auscultation throughout her chest. Heart sounds were normal with no murmur, JVP was flat, mucous membranes were dry and there was no peripheral edema. Abdominal examination was normal. The patient was intubated and transferred to the ICU.	2.1 Demonstrate an understanding of what knowledge is, the strengths and limitations of different ways of knowing, and how knowledge is created in historical, cultural and social contexts. 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Explain the possible underlying mechanisms of edema, hypertension, oliguria and renal insufficiency and apply them to clinical presentations.	Active Large Group Session: Case-Based Nephrology Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease Tutorial: Ivan Horvath MF2 Renal Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension. Tutorial: Maria Rossi MF2 Renal Maria Rossi is a 21-year-old woman who comes to the emergency department for treatment of a headache. She has been having worsening headaches for several weeks and today the pain is severe and has not responded to Tylenol. The triage nurse measures her blood pressure and finds it to be 220/110. Maria is put on a monitor and full examination by the emergency room physician reveals retinal exudates and an abdominal bruit. Blood work is sent to the lab.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Explain the primary mechanisms responsible for hypernatremia, hyponatremia, hyperkalemia, hypokalemia and metabolic acidosis and apply them to clinical presentations.	Active Large Group Session: Case-Based Nephrology Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease Tutorial: Nancy Jones MF2 Renal Nancy Jones is a 34-year-old Mohawk, Turtle Clan woman who has been well until four days prior to hospital admission when she developed abrupt onset of chills, rigors, and a productive cough. Subsequently Mrs. Jones became progressively short of breath, was obtunded and bedridden and was brought to the hospital emergency room. On arrival, her vital signs were blood pressure 80/60 mmHg, heart rate 148 beats/min, respiratory rate 42/min, temperature 39.6o C, and oxygen saturation 79% on room air. She was confused. Crackles were heard on auscultation throughout her chest. Heart sounds were normal with no murmur, JVP was flat, mucous membranes were dry and there was no peripheral edema. Abdominal examination was normal. The patient was intubated and transferred to the ICU.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Elicit the relevant history for renal disease	Clinical Skills Sessions: Introduction and Overview of Volume Status Exam To discuss and to practice the components of the Volume status history and physical examination.	1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Conduct a physical examination appropriate to the clinical problem presented	Clinical Skills Practice Sessions: Renal Examination and Volume Assessment These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.	1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests. 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Devise hypotheses regarding the mechanisms responsible for the patient's complaint.	Clinical Skills Practice Sessions: Renal Examination and Volume Assessment These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group. Tutorial: All MF2 Renal tutorial problems	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Choose and then analyze laboratory tests which would permit you to investigate systematically each of your hypotheses.	Active Large Group Session: Case-Based Nephrology Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: All MF2 Renal tutorial problems Tutorial: Maria Rossi MF2 Renal Maria Rossi is a 21-year-old woman who comes to the emergency department for treatment of a headache. She has been having worsening headaches for several weeks and today the pain is severe and has not responded to Tylenol. The triage nurse measures her blood pressure and finds it to be 220/110. Maria is put on a monitor and full examination by the emergency room physician reveals retinal exudates and an abdominal bruit. Blood work is sent to the lab.	1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Explain the mechanisms of action of diuretics, ACE inhibitors, and angiotensin receptor blocking (ARB) agents and apply them to appropriate clinical scenarios.	Active Large Group Session: Case-Based Nephrology Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: Maria Rossi MF2 Renal Maria Rossi is a 21-year-old woman who comes to the emergency department for treatment of a headache. She has been having worsening headaches for several weeks and today the pain is severe and has not responded to Tylenol. The triage nurse measures her blood pressure and finds it to be 220/110. Maria is put on a monitor and full examination by the emergency room physician reveals retinal exudates and an abdominal bruit. Blood work is sent to the lab.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Explain the nephrotoxic potential of certain drugs.	Tutorial: Ivan Horvath MF2 Renal Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension. Tutorial: Yong Mun Park MF2 Renal Yong Mun Park is a 22 year old woman who has a 2 year history of recurrent urinary tract infections. These continue despite conservative measures and her family doctor elects to try her on a course of prophylactic antibiotics. She is allergic to sulpha medications, so she is prescribed cephalexin 250 mg daily. She is taking an oral contraceptive, but no other medications. Ten days after starting this antibiotic, she returns to her family doctor with a macular, red rash on her trunk and arms, general malaise, and nausea.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Themes
The Kidney: Structure and Function
Explain the structure, function and physiology of the urinary tract, kidney, nephron and glomerulus	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules). Tutorial: Ivan Horvath MF2 Renal Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe the role of renal blood flow, capillary hydrostatic pressure and capillary.	Tutorial: Ivan Horvath MF2 Renal Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe and the relationship between serum creatinine and GFR.	Tutorial: Nancy Jones MF2 Renal Nancy Jones is a 34-year-old Mohawk, Turtle Clan woman who has been well until four days prior to hospital admission when she developed abrupt onset of chills, rigors, and a productive cough. Subsequently Mrs. Jones became progressively short of breath, was obtunded and bedridden and was brought to the hospital emergency room. On arrival, her vital signs were blood pressure 80/60 mmHg, heart rate 148 beats/min, respiratory rate 42/min, temperature 39.6o C, and oxygen saturation 79% on room air. She was confused. Crackles were heard on auscultation throughout her chest. Heart sounds were normal with no murmur, JVP was flat, mucous membranes were dry and there was no peripheral edema. Abdominal examination was normal. The patient was intubated and transferred to the ICU. Tutorial: Yong Mun Park MF2 Renal Yong Mun Park is a 22 year old woman who has a 2 year history of recurrent urinary tract infections. These continue despite conservative measures and her family doctor elects to try her on a course of prophylactic antibiotics. She is allergic to sulpha medications, so she is prescribed cephalexin 250 mg daily. She is taking an oral contraceptive, but no other medications. Ten days after starting this antibiotic, she returns to her family doctor with a macular, red rash on her trunk and arms, general malaise, and nausea.	1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice 2.1 Demonstrate an understanding of what knowledge is, the strengths and limitations of different ways of knowing, and how knowledge is created in historical, cultural and social contexts. 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe and interpret investigations (urinalysis, blood tests, imaging) in the diagnosis of renal pathology.	Tutorial: All MF2 Renal tutorial problems	1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice
Describe the pathogenesis and clinical significance of infection involving the urinary tract.	Tutorial: Celia and Maria MF2 Renal Maria is a 33 year old single woman who is concerned about the health of her 2 year old daughter Celia. Since three months of age Celia has been treated with multiple course of antibiotics for episodes of fever and irritability. Maria wants the doctor to check a urine sample because she thinks it might be a "urine infection" since Celia's wet diapers have a bad smell	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
The Kidney: Regulation of Fluid Compartments, Electrolytes, and Hypertension
Regulation of fluid compartment size and osmolality
Describe the determinants of intracellular fluid (ICF) and extracellular fluid (ECF) volume.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: Matthew Clarke MF2 Renal Matthew Clarke, a 4-year-old boy, developed periorbital edema for the first time three weeks ago, and despite being treated for allergies he showed increasing edema and weight gain. He now has ankle and leg edema, a distended abdomen, and can only sleep at night if propped up with three or four pillows.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe the normal distribution of sodium, potassium and water in the ICF and ECF compartments.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Define osmolality.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: George Haycock MF2 Renal Mr. Haycock is a 20-year-old student who presented to ER with a 5 day history of diarrhea and vomiting which started at the end of his trip to the Caribbean. Past medical history is significant for epilepsy controlled with carbamazepine. Vital signs: HR – 100/min, RR – 15/min, BP – 80/50 mmHg, Saturation – 99% in room air. Physical examination revealed dry mucous membranes, prolonged capillary refill time of 4 seconds.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Demonstrate the role of the sodium ion in determining the osmolality of the ECF and its clinical manifestations.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: George Haycock MF2 Renal Mr. Haycock is a 20-year-old student who presented to ER with a 5 day history of diarrhea and vomiting which started at the end of his trip to the Caribbean. Past medical history is significant for epilepsy controlled with carbamazepine. Vital signs: HR – 100/min, RR – 15/min, BP – 80/50 mmHg, Saturation – 99% in room air. Physical examination revealed dry mucous membranes, prolonged capillary refill time of 4 seconds.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Circulating volume
Describe and apply how the total amount of sodium in the body determines the volume of the intravascular space.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: George Haycock MF2 Renal Mr. Haycock is a 20-year-old student who presented to ER with a 5 day history of diarrhea and vomiting which started at the end of his trip to the Caribbean. Past medical history is significant for epilepsy controlled with carbamazepine. Vital signs: HR – 100/min, RR – 15/min, BP – 80/50 mmHg, Saturation – 99% in room air. Physical examination revealed dry mucous membranes, prolonged capillary refill time of 4 seconds.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Understand how the kidney conserves sodium appropriately during hypovolemic states, and inappropriately in the setting of congestive heart failure.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Illustrate the mechanisms by which the kidney may excrete a dilute versus concentrated urine.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Describe the relationship between total body water and the serum sodium concentration.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: George Haycock MF2 Renal Mr. Haycock is a 20-year-old student who presented to ER with a 5 day history of diarrhea and vomiting which started at the end of his trip to the Caribbean. Past medical history is significant for epilepsy controlled with carbamazepine. Vital signs: HR – 100/min, RR – 15/min, BP – 80/50 mmHg, Saturation – 99% in room air. Physical examination revealed dry mucous membranes, prolonged capillary refill time of 4 seconds.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Hypertension
Explain the mechanisms responsible for maintaining blood pressure in the normal range.	Tutorial: Ivan Horvath MF2 Renal Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Explain the pathological consequences of hypertension on the brain, heart and kidneys.	Tutorial: Ivan Horvath MF2 Renal Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations
Explain the mechanisms responsible for essential and secondary hypertension.	Tutorial: Ivan Horvath MF2 Renal Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension. Tutorial: Maria Rossi MF2 Renal Maria Rossi is a 21-year-old woman who comes to the emergency department for treatment of a headache. She has been having worsening headaches for several weeks and today the pain is severe and has not responded to Tylenol. The triage nurse measures her blood pressure and finds it to be 220/110. Maria is put on a monitor and full examination by the emergency room physician reveals retinal exudates and an abdominal bruit. Blood work is sent to the lab.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations
Explain the mechanisms responsible for elevation of blood pressure in the setting of renal artery stenosis.	Tutorial: Maria Rossi MF2 Renal Maria Rossi is a 21-year-old woman who comes to the emergency department for treatment of a headache. She has been having worsening headaches for several weeks and today the pain is severe and has not responded to Tylenol. The triage nurse measures her blood pressure and finds it to be 220/110. Maria is put on a monitor and full examination by the emergency room physician reveals retinal exudates and an abdominal bruit. Blood work is sent to the lab.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Explain the mechanisms of action by which diuretics, beta blockers, ACE inhibitors, ARBs, and calcium channel blockers reduce elevated blood pressure.	Tutorial: Ivan Horvath MF2 Renal Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Potassium
Describe the main sites of potassium reabsorption in the nephron.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: Michelle Broyer MF2 Renal Ms. Broyer is a 22-year-old female who moved to the local area and enrolled in your practice. Past medical history is significant for several episodes of muscle cramps and intermittent muscle weakness.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe how potassium secretion by the kidney regulates the serum potassium concentration.	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: Michelle Broyer MF2 Renal Ms. Broyer is a 22-year-old female who moved to the local area and enrolled in your practice. Past medical history is significant for several episodes of muscle cramps and intermittent muscle weakness.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe the role of the following in the secretion of potassium by the kidney: aldosterone activity and tubular flow rate	Active Large Group Session: Electrolytes - Sodium and Potassium Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia Tutorial: Michelle Broyer MF2 Renal Ms. Broyer is a 22-year-old female who moved to the local area and enrolled in your practice. Past medical history is significant for several episodes of muscle cramps and intermittent muscle weakness.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Acid Base Homeostasis
Describe the pathogenesis and clinical significance of infection involving the urinary tract.	Tutorial: Celia and Maria MF2 Renal Maria is a 33 year old single woman who is concerned about the health of her 2 year old daughter Celia. Since three months of age Celia has been treated with multiple course of antibiotics for episodes of fever and irritability. Maria wants the doctor to check a urine sample because she thinks it might be a "urine infection" since Celia's wet diapers have a bad smell	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe how the body deals with an acid load with reference to: Buffer systems (bicarbonate, hemoglobin); Lungs (alveolar ventilation); Kidneys (net acid excretion).	Active Large Group Session: Acid Base Disorders Respiratory acidosis. Metabolic acidosis. Respiratory Alkalosis. Metabolic Alkalosis. Tutorial: Amir Boutros MF2 Renal Amir Boutros is a 30 year old man with a history of Crohn's disease who presents to the hospital with a recent history of increased pain and diarrhea. He is very weak, dizzy and short of breath. His BP is 80/50 with a heart rate of 120 and respiratory rate of 24. His chest X-ray is normal. Tutorial: Elena Christakos MF2 Renal Elena Christakos is a 54 yr old lady who presents to the Emergency Room with a 48 hr history of fever (temp up to 39.6 degrees celsius), chills, and weakness. Her condition in the ER deteriorates; BP falls to 80/50 and she becomes anuric. She is thought to be developing septic shock and is transferred to the ICU.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe the kidney's role in acid base balance with reference to: Reclamation by the kidney of filtered bicarbonate and acid excretion via the glutamine-ammonium system	Active Large Group Session: Acid Base Disorders Respiratory acidosis. Metabolic acidosis. Respiratory Alkalosis. Metabolic Alkalosis. Tutorial: Elena Christakos MF2 Renal Elena Christakos is a 54 yr old lady who presents to the Emergency Room with a 48 hr history of fever (temp up to 39.6 degrees celsius), chills, and weakness. Her condition in the ER deteriorates; BP falls to 80/50 and she becomes anuric. She is thought to be developing septic shock and is transferred to the ICU.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe the relationship between pH and hydrogen ion concentration.	Active Large Group Session: Acid Base Disorders Respiratory acidosis. Metabolic acidosis. Respiratory Alkalosis. Metabolic Alkalosis. Tutorial: Elena Christakos MF2 Renal Elena Christakos is a 54 yr old lady who presents to the Emergency Room with a 48 hr history of fever (temp up to 39.6 degrees celsius), chills, and weakness. Her condition in the ER deteriorates; BP falls to 80/50 and she becomes anuric. She is thought to be developing septic shock and is transferred to the ICU.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Employ an approach to metabolic acidosis including using the anion gap to solve clinical problems.	Active Large Group Session: Acid Base Disorders Respiratory acidosis. Metabolic acidosis. Respiratory Alkalosis. Metabolic Alkalosis. Tutorial: Amir Boutros MF2 Renal Amir Boutros is a 30 year old man with a history of Crohn's disease who presents to the hospital with a recent history of increased pain and diarrhea. He is very weak, dizzy and short of breath. His BP is 80/50 with a heart rate of 120 and respiratory rate of 24. His chest X-ray is normal. Tutorial: Elena Christakos MF2 Renal Elena Christakos is a 54 yr old lady who presents to the Emergency Room with a 48 hr history of fever (temp up to 39.6 degrees celsius), chills, and weakness. Her condition in the ER deteriorates; BP falls to 80/50 and she becomes anuric. She is thought to be developing septic shock and is transferred to the ICU.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
The Kidney and Systemic Disease, Chronic Kidney Disease, Acute Kidney Injury
Describe the mechanisms by which GFR may be reduced in both acute and chronic kidney disease.	Tutorial: Nancy Jones MF2 Renal Nancy Jones is a 34-year-old Mohawk, Turtle Clan woman who has been well until four days prior to hospital admission when she developed abrupt onset of chills, rigors, and a productive cough. Subsequently Mrs. Jones became progressively short of breath, was obtunded and bedridden and was brought to the hospital emergency room. On arrival, her vital signs were blood pressure 80/60 mmHg, heart rate 148 beats/min, respiratory rate 42/min, temperature 39.6o C, and oxygen saturation 79% on room air. She was confused. Crackles were heard on auscultation throughout her chest. Heart sounds were normal with no murmur, JVP was flat, mucous membranes were dry and there was no peripheral edema. Abdominal examination was normal. The patient was intubated and transferred to the ICU.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe the role of the urinalysis in detecting the presence of glomerular disease.	Tutorial: Matthew Clarke MF2 Renal Matthew Clarke, a 4-year-old boy, developed periorbital edema for the first time three weeks ago, and despite being treated for allergies he showed increasing edema and weight gain. He now has ankle and leg edema, a distended abdomen, and can only sleep at night if propped up with three or four pillows. Tutorial: Yong Mun Park MF2 Renal Yong Mun Park is a 22 year old woman who has a 2 year history of recurrent urinary tract infections. These continue despite conservative measures and her family doctor elects to try her on a course of prophylactic antibiotics. She is allergic to sulpha medications, so she is prescribed cephalexin 250 mg daily. She is taking an oral contraceptive, but no other medications. Ten days after starting this antibiotic, she returns to her family doctor with a macular, red rash on her trunk and arms, general malaise, and nausea.	1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice 2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe the mechanisms of the anemia observed in patients with advanced chronic kidney disease or end stage renal disease.	Active Large Group Session: Case-Based Nephrology Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe the role of erythropoietin in the maintenance of a normal hemoglobin.		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe how parathyroid hormone and vitamin D act on the gastrointestinal system, bone, and kidney to regulate serum calcium and phosphate balance.		2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe and apply the paradigm of pre-renal, renal and post-renal processes that can lead to acute kidney injury.	Active Large Group Session: Case-Based Nephrology Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations. 2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare
Drugs and the Kidney
Describe and apply the role of the kidney in the metabolism and excretion of drugs.	Tutorial: Yong Mun Park MF2 Renal Yong Mun Park is a 22 year old woman who has a 2 year history of recurrent urinary tract infections. These continue despite conservative measures and her family doctor elects to try her on a course of prophylactic antibiotics. She is allergic to sulpha medications, so she is prescribed cephalexin 250 mg daily. She is taking an oral contraceptive, but no other medications. Ten days after starting this antibiotic, she returns to her family doctor with a macular, red rash on her trunk and arms, general malaise, and nausea.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Explain the mechanisms of action by which diuretics, beta blockers, ACE inhibitors, ARBs, and calcium channel blockers reduce elevated blood pressure.	Tutorial: Matthew Clarke MF2 Renal Matthew Clarke, a 4-year-old boy, developed periorbital edema for the first time three weeks ago, and despite being treated for allergies he showed increasing edema and weight gain. He now has ankle and leg edema, a distended abdomen, and can only sleep at night if propped up with three or four pillows.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Renal system anatomy
Understand surface anatomy corresponding to the kidneys, ureters, bladder and urethra.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe and identify the fibrous capsule, perirenal fat, renal fascia and pararenal fat and understand their function.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Understand the renal cortex, medulla, renal pyramids, renal papilla, renal columns.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules). Tutorial: Matthew Clarke MF2 Renal Matthew Clarke, a 4-year-old boy, developed periorbital edema for the first time three weeks ago, and despite being treated for allergies he showed increasing edema and weight gain. He now has ankle and leg edema, a distended abdomen, and can only sleep at night if propped up with three or four pillows.	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Understand the structure and function of the renal pelvis, major and minor calyces and renal papilla.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Understand the arterial supply of the kidneys (renal arteries, segmental arteries, lobar arteries, interlobar arteries, arcuate arteries, interlobular arteries and afferent glomerular arterioles.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Understand the venous and lymphatic drainage as well as the innervations of the kidney.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Understand the development of the common congenital anomalies of the kidney.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Identify the ureter, its length, division, and the three sites of constrictions along its course.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Identify and describe the arterial supply of the ureter, venous and lymphatic drainage and its innervation.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe the urinary bladder its location, neck and surfaces (posterior (base), superior, and inferolateral surfaces).	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Understand the mucous membrane of the bladder, trigone, muscular coat of the bladder (detrusor muscle) and the internal sphincter (sphincter vesicae).	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Understand the arterial supply, venous and lymphatic drainage of the bladder.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Describe and understand innervation of the bladder with a focus on mechanism of micturition.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Identify the external sphincter (sphincter urethrae) and urethral meatus. Understand the different parts of male urethra (prostatic, membranous, spongy (penile) urethra) and the differences between male and female urethra.	Anatomy Lectures: Renal System Anatomy Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).	2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.
Tutorial Cases
Activities

Objectives

Linked Activities

McMaster Program Competencies

General Objectives

Explain the structure, function and physiology of the urinary tract, kidney, nephron and glomerulus

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

Tutorial: Celia and Maria MF2 Renal

Maria is a 33 year old single woman who is concerned about the health of her 2 year old daughter Celia. Since three months of age Celia has been treated with multiple course of antibiotics for episodes of fever and irritability. Maria wants the doctor to check a urine sample because she thinks it might be a "urine infection" since Celia's wet diapers have a bad smell

Tutorial: Ivan Horvath MF2 Renal

Ivan Horvath is a 70-year-old male with poorly controlled hypertension for approximately 20 years, dyslipidemia, and peripheral vascular disease. He has a 60 pack-year history of smoking. He has difficulty walking more than one block due to the development of pain in his legs. He has recently moved and you see him with his new family physician. He currently takes amlodipine (calcium channel blocker) and chlorthalidone (thiazide diuretic) for his hypertension.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

Describe renal and bladder anatomy and visualize with an ultrasound.

Tutorial: Celia and Maria MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe normal renal pathology.

Active Large Group Session: Introduction to Renal Pathology

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Explain the concept of glomerular filtration rate and renal clearance of solutes, drugs and toxins.

Tutorial: Nancy Jones MF2 Renal

Nancy Jones is a 34-year-old Mohawk, Turtle Clan woman who has been well until four days prior to hospital admission when she developed abrupt onset of chills, rigors, and a productive cough. Subsequently Mrs. Jones became progressively short of breath, was obtunded and bedridden and was brought to the hospital emergency room. On arrival, her vital signs were blood pressure 80/60 mmHg, heart rate 148 beats/min, respiratory rate 42/min, temperature 39.6o C, and oxygen saturation 79% on room air. She was confused. Crackles were heard on auscultation throughout her chest. Heart sounds were normal with no murmur, JVP was flat, mucous membranes were dry and there was no peripheral edema. Abdominal examination was normal. The patient was intubated and transferred to the ICU.

2.1 Demonstrate an understanding of what knowledge is, the strengths and limitations of different ways of knowing, and how knowledge is created in historical, cultural and social contexts.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Explain the possible underlying mechanisms of edema, hypertension, oliguria and renal insufficiency and apply them to clinical presentations.

Active Large Group Session: Case-Based Nephrology

Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease

Tutorial: Ivan Horvath MF2 Renal

Tutorial: Maria Rossi MF2 Renal

Maria Rossi is a 21-year-old woman who comes to the emergency department for treatment of a headache. She has been having worsening headaches for several weeks and today the pain is severe and has not responded to Tylenol. The triage nurse measures her blood pressure and finds it to be 220/110. Maria is put on a monitor and full examination by the emergency room physician reveals retinal exudates and an abdominal bruit. Blood work is sent to the lab.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Explain the primary mechanisms responsible for hypernatremia, hyponatremia, hyperkalemia, hypokalemia and metabolic acidosis and apply them to clinical presentations.

Active Large Group Session: Case-Based Nephrology

Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease

Tutorial: Nancy Jones MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Elicit the relevant history for renal disease

Clinical Skills Sessions: Introduction and Overview of Volume Status Exam

To discuss and to practice the components of the Volume status history and physical examination.

1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Conduct a physical examination appropriate to the clinical problem presented

Clinical Skills Practice Sessions: Renal Examination and Volume Assessment

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

1.1 Gather essential and accurate information about patients and their health through history-taking, physical examination, and the use of laboratory data, imaging, and other tests.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Devise hypotheses regarding the mechanisms responsible for the patient's complaint.

Clinical Skills Practice Sessions: Renal Examination and Volume Assessment

These practice sessions are intended to improve standardization of teaching across groups and to provide tutorial groups with opportunities to focus on areas of particular concern to the group.

Tutorial: All MF2 Renal tutorial problems

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

Choose and then analyze laboratory tests which would permit you to investigate systematically each of your hypotheses.

Active Large Group Session: Case-Based Nephrology

Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: All MF2 Renal tutorial problems

Tutorial: Maria Rossi MF2 Renal

1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Explain the mechanisms of action of diuretics, ACE inhibitors, and angiotensin receptor blocking (ARB) agents and apply them to appropriate clinical scenarios.

Active Large Group Session: Case-Based Nephrology

Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: Maria Rossi MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Explain the nephrotoxic potential of certain drugs.

Tutorial: Ivan Horvath MF2 Renal

Tutorial: Yong Mun Park MF2 Renal

Yong Mun Park is a 22 year old woman who has a 2 year history of recurrent urinary tract infections. These continue despite conservative measures and her family doctor elects to try her on a course of prophylactic antibiotics. She is allergic to sulpha medications, so she is prescribed cephalexin 250 mg daily. She is taking an oral contraceptive, but no other medications. Ten days after starting this antibiotic, she returns to her family doctor with a macular, red rash on her trunk and arms, general malaise, and nausea.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

Themes

The Kidney: Structure and Function

Explain the structure, function and physiology of the urinary tract, kidney, nephron and glomerulus

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

Tutorial: Ivan Horvath MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe the role of renal blood flow, capillary hydrostatic pressure and capillary.

Tutorial: Ivan Horvath MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe and the relationship between serum creatinine and GFR.

Tutorial: Nancy Jones MF2 Renal

Tutorial: Yong Mun Park MF2 Renal

1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice

2.1 Demonstrate an understanding of what knowledge is, the strengths and limitations of different ways of knowing, and how knowledge is created in historical, cultural and social contexts.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe and interpret investigations (urinalysis, blood tests, imaging) in the diagnosis of renal pathology.

Tutorial: All MF2 Renal tutorial problems

1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice

Describe the pathogenesis and clinical significance of infection involving the urinary tract.

Tutorial: Celia and Maria MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

The Kidney: Regulation of Fluid Compartments, Electrolytes, and Hypertension

Regulation of fluid compartment size and osmolality

Describe the determinants of intracellular fluid (ICF) and extracellular fluid (ECF) volume.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: Matthew Clarke MF2 Renal

Matthew Clarke, a 4-year-old boy, developed periorbital edema for the first time three weeks ago, and despite being treated for allergies he showed increasing edema and weight gain. He now has ankle and leg edema, a distended abdomen, and can only sleep at night if propped up with three or four pillows.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe the normal distribution of sodium, potassium and water in the ICF and ECF compartments.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Define osmolality.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: George Haycock MF2 Renal

Mr. Haycock is a 20-year-old student who presented to ER with a 5 day history of diarrhea and vomiting which started at the end of his trip to the Caribbean. Past medical history is significant for epilepsy controlled with carbamazepine. Vital signs: HR – 100/min, RR – 15/min, BP – 80/50 mmHg, Saturation – 99% in room air. Physical examination revealed dry mucous membranes, prolonged capillary refill time of 4 seconds.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Demonstrate the role of the sodium ion in determining the osmolality of the ECF and its clinical manifestations.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: George Haycock MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Circulating volume

Describe and apply how the total amount of sodium in the body determines the volume of the intravascular space.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: George Haycock MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

Understand how the kidney conserves sodium appropriately during hypovolemic states, and inappropriately in the setting of congestive heart failure.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

Illustrate the mechanisms by which the kidney may excrete a dilute versus concentrated urine.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

Describe the relationship between total body water and the serum sodium concentration.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: George Haycock MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Hypertension

Explain the mechanisms responsible for maintaining blood pressure in the normal range.

Tutorial: Ivan Horvath MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Explain the pathological consequences of hypertension on the brain, heart and kidneys.

Tutorial: Ivan Horvath MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resource allocation, and disease prevention/health promotion efforts for patients and populations

Explain the mechanisms responsible for essential and secondary hypertension.

Tutorial: Ivan Horvath MF2 Renal

Tutorial: Maria Rossi MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Explain the mechanisms responsible for elevation of blood pressure in the setting of renal artery stenosis.

Tutorial: Maria Rossi MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

Explain the mechanisms of action by which diuretics, beta blockers, ACE inhibitors, ARBs, and calcium channel blockers reduce elevated blood pressure.

Tutorial: Ivan Horvath MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Potassium

Describe the main sites of potassium reabsorption in the nephron.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: Michelle Broyer MF2 Renal

Ms. Broyer is a 22-year-old female who moved to the local area and enrolled in your practice. Past medical history is significant for several episodes of muscle cramps and intermittent muscle weakness.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe how potassium secretion by the kidney regulates the serum potassium concentration.

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: Michelle Broyer MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe the role of the following in the secretion of potassium by the kidney: aldosterone activity and tubular flow rate

Active Large Group Session: Electrolytes - Sodium and Potassium

Nephron structure and tubular functions. Diuretics and their sites and actions. Bartter and Gitelman syndromes. Hypo and hypernatremia. Hypo and hyperkalemia

Tutorial: Michelle Broyer MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Acid Base Homeostasis

Describe the pathogenesis and clinical significance of infection involving the urinary tract.

Tutorial: Celia and Maria MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe how the body deals with an acid load with reference to: Buffer systems (bicarbonate, hemoglobin); Lungs (alveolar ventilation); Kidneys (net acid excretion).

Active Large Group Session: Acid Base Disorders

Respiratory acidosis. Metabolic acidosis. Respiratory Alkalosis. Metabolic Alkalosis.

Tutorial: Amir Boutros MF2 Renal

Amir Boutros is a 30 year old man with a history of Crohn's disease who presents to the hospital with a recent history of increased pain and diarrhea. He is very weak, dizzy and short of breath. His BP is 80/50 with a heart rate of 120 and respiratory rate of 24. His chest X-ray is normal.

Tutorial: Elena Christakos MF2 Renal

Elena Christakos is a 54 yr old lady who presents to the Emergency Room with a 48 hr history of fever (temp up to 39.6 degrees celsius), chills, and weakness. Her condition in the ER deteriorates; BP falls to 80/50 and she becomes anuric. She is thought to be developing septic shock and is transferred to the ICU.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe the kidney's role in acid base balance with reference to: Reclamation by the kidney of filtered bicarbonate and acid excretion via the glutamine-ammonium system

Active Large Group Session: Acid Base Disorders

Respiratory acidosis. Metabolic acidosis. Respiratory Alkalosis. Metabolic Alkalosis.

Tutorial: Elena Christakos MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe the relationship between pH and hydrogen ion concentration.

Active Large Group Session: Acid Base Disorders

Respiratory acidosis. Metabolic acidosis. Respiratory Alkalosis. Metabolic Alkalosis.

Tutorial: Elena Christakos MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Employ an approach to metabolic acidosis including using the anion gap to solve clinical problems.

Active Large Group Session: Acid Base Disorders

Respiratory acidosis. Metabolic acidosis. Respiratory Alkalosis. Metabolic Alkalosis.

Tutorial: Amir Boutros MF2 Renal

Tutorial: Elena Christakos MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

The Kidney and Systemic Disease, Chronic Kidney Disease, Acute Kidney Injury

Describe the mechanisms by which GFR may be reduced in both acute and chronic kidney disease.

Tutorial: Nancy Jones MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe the role of the urinalysis in detecting the presence of glomerular disease.

Tutorial: Matthew Clarke MF2 Renal

Tutorial: Yong Mun Park MF2 Renal

1.3 Interpret laboratory data, imaging studies, and other tests required for the area of practice

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe the mechanisms of the anemia observed in patients with advanced chronic kidney disease or end stage renal disease.

Active Large Group Session: Case-Based Nephrology

Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe the role of erythropoietin in the maintenance of a normal hemoglobin.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe how parathyroid hormone and vitamin D act on the gastrointestinal system, bone, and kidney to regulate serum calcium and phosphate balance.

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe and apply the paradigm of pre-renal, renal and post-renal processes that can lead to acute kidney injury.

Active Large Group Session: Case-Based Nephrology

Case based review of topics from renal subunit: Sodium, Potassium, Acid-Base, Hypertension, Acute kidney injury, Chronic kidney disease

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

2.3 Apply principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based healthcare

Drugs and the Kidney

Describe and apply the role of the kidney in the metabolism and excretion of drugs.

Tutorial: Yong Mun Park MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Explain the mechanisms of action by which diuretics, beta blockers, ACE inhibitors, ARBs, and calcium channel blockers reduce elevated blood pressure.

Tutorial: Matthew Clarke MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Renal system anatomy

Understand surface anatomy corresponding to the kidneys, ureters, bladder and urethra.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe and identify the fibrous capsule, perirenal fat, renal fascia and pararenal fat and understand their function.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Understand the renal cortex, medulla, renal pyramids, renal papilla, renal columns.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

Tutorial: Matthew Clarke MF2 Renal

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Understand the structure and function of the renal pelvis, major and minor calyces and renal papilla.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Understand the arterial supply of the kidneys (renal arteries, segmental arteries, lobar arteries, interlobar arteries, arcuate arteries, interlobular arteries and afferent glomerular arterioles.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Understand the venous and lymphatic drainage as well as the innervations of the kidney.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Understand the development of the common congenital anomalies of the kidney.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Identify the ureter, its length, division, and the three sites of constrictions along its course.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Identify and describe the arterial supply of the ureter, venous and lymphatic drainage and its innervation.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe the urinary bladder its location, neck and surfaces (posterior (base), superior, and inferolateral surfaces).

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Understand the mucous membrane of the bladder, trigone, muscular coat of the bladder (detrusor muscle) and the internal sphincter (sphincter vesicae).

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Understand the arterial supply, venous and lymphatic drainage of the bladder.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Describe and understand innervation of the bladder with a focus on mechanism of micturition.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Identify the external sphincter (sphincter urethrae) and urethral meatus. Understand the different parts of male urethra (prostatic, membranous, spongy (penile) urethra) and the differences between male and female urethra.

Anatomy Lectures: Renal System Anatomy

Renal Anatomy (Gross and Vasculature) Anatomy and Physiology (Nephron, Glomerulus, Tubules).

2.2 Apply biomedical scientific principles fundamental to health care for patients and populations.

Tutorial Cases

Activities